Does CBD Work for Constipation?

  • Constipation, a digestive issue, is a common symptom of gastrointestinal tract disorders, such as inflammatory bowel disease and irritable bowel syndrome.
  • Studies have shown that medical cannabis has eased the symptoms of those suffering from inflammatory bowel diseases, such as ulcerative colitis and Crohn’s disease(1). CBD is a compound present in varying amounts in cannabis plants.
  • Some people use CBD to treat symptoms of constipation(2). These symptoms include stomach ache, nausea, and bloating.
  • Diarrhea is one of the possible side effects of taking CBD. Diarrhea is the opposite of constipation and may bring further digestive complications if induced(3).
  • Further clinical trials and medical research are needed for CBD to be claimed as a treatment for constipation.

Why People Are Using CBD for Constipation

Constipation is a digestive issue that is often treated with over-the-counter laxatives(4). These drugs contain substances that either loosen stools or increase the bowel movement. 

However, the overuse and misuse of these drugs can cause side effects, such as bloating, stomach pain, and diarrhea. In some cases, a patient becomes dependent on laxatives and develops eating disorders or diarrhea(5)

Meanwhile, other severe gastrointestinal (GI) issues, such as chronic constipation and irritable bowel syndrome (IBS), need prescription medications. These disorders can affect the entire GI tract, from mouth to anus. 

Chronic constipation is described as having difficulty in bowel movements, which can last for several weeks. 

There are two causes of constipation. The primary cause has something to do with the dysfunction of the colon and rectum. The secondary cause can be a result of an organic or systemic disease or medications(6)

IBS is a chronic gastrointestinal disorder that affects the large intestine. People with IBS experience constipation, diarrhea, or, in rare cases, both. 

There is no cure for IBS, and its specific cause remains unknown. Medications, such as anti-diarrhea drugs and laxatives, can only help alleviate the symptoms. 

However, prescription drugs are known to cause GI side effects that can start as a mild condition and progress into severe problems, like organ hemorrhage(7). GI side effects include diarrhea and flatulence.

To prevent severe digestive and GI problems caused by drug prescriptions, some people use cannabidiol to treat symptoms of constipation(8).

CBD or cannabidiol is a non-psychoactive compound found in the cannabis plant. The oil is extracted from hemp, a cannabis plant that contains high CBD levels. 

Studies have shown that medical cannabis has eased the symptoms of those suffering from inflammatory bowel diseases (IBD), such as ulcerative colitis and Crohn’s disease(9). Medical cannabis is using the cannabis plant, along with its concentrates, for medicinal purposes.

IBDs are often treated with prescription drugs, such as steroids (corticosteroids), immunomodulators, and biologic agents. However, these treatments carry long-term effects, like malignancy and infection(10).

In a study, patients with ulcerative colitis were given CBD to help treat inflammation(11). Ulcerative colitis is an IBD that causes inflammation in the digestive tract, specifically in the large intestine and rectum. 

Similar to ulcerative colitis, Crohn’s disease is an IBD that inflames the GI tract. Patients with Crohn’s disease are likely to develop mental health issues, like anxiety and depression(12)

A case study about the correlation between Crohn’s disease and anxiety and using CBD as a treatment was published recently(13). Results showed that CBD’s calming effect on the nerves might help ease the anxiety of those with Crohn’s disease. 

Compared with the drugs mentioned, CBD has a good safety profile with no adverse side effects(14).

How CBD Oil Works to Help Alleviate Symptoms of Constipation

Besides painful bowel movements, constipation symptoms include stomach ache and cramps, nausea, and bloating. These symptoms may reduce the quality of life and hamper the routine activities of a person.

Dehydration and a diet low in fiber and high in dairy can cause constipation. Some medications, such as opioids, anticholinergics, and calcium channel blockers, can also induce constipation(15)

Opioids are narcotic pain medications, while anticholinergics are used to treat various conditions, such as involuntary muscle movements and chronic obstructive pulmonary disease. Calcium channel blockers are prescribed to lower blood pressure.

Before administering any CBD product, it is essential to understand how it works in the body, especially with the endocannabinoid system (ECS). CBD binds with the cannabinoid receptors of the body’s ECS. 

The ECS is the body’s system responsible for maintaining equilibrium or homeostasis by regulating one’s sleep, mood, appetite, pain reception, and memory(16).

Endocannabinoids, the natural cannabinoids of the body, work with CB1 and CB2 receptors to communicate with different parts of the body, including the gut. 

CBD for Stomach Ache

People use CBD for multiple medical reasons, one of which is pain reduction(17). A study that examined the use of medical cannabis for chronic pain indicated that the subjects reported reduced pain(18). The intake of opioids was also significantly reduced.

Medical cannabis is a plant-based treatment that contains two major compounds: CBD and THC. Tetrahydrocannabinol (THC) is an active compound that makes a person high.

Similarly, a study about pain management showed results that CBD and THC could reduce pain that is difficult to manage(19). These cannabinoids are found in the form of a mouth spray, which is a prescribed treatment for various pains caused by multiple sclerosis. 

CBD for Nausea

Nausea is a common symptom of constipation and other GI disorders. It is characterized by stomach discomfort that may lead to vomiting. 

Cannabis-based products, like an oral spray with THC and CBD, may effectively reduce nausea and vomiting in patients undergoing chemotherapy(20)

In another study, CBD was also shown to be potentially useful in suppressing nausea and vomiting before, after, or during a chemotherapy session(21). Nausea and vomiting is a common side effect of chemotherapy treatment. 

CBD for Bloating

Bloating caused by constipation can be a sign of inflammation in the digestive system. 

In a study conducted on mice, the test subjects were induced with an intestine inflammation to see if CBD oil helped relieve the inflammation(22). Results showed that intestinal contractions, together with the inflammation and pain, were all inhibited using CBD oil.

Similar studies showed that the ECS of mice with inflamed colons could be activated and function as a protection against inflammation(23). The CB1 receptors were activated, and they presented a promising therapeutic potential for GI diseases with symptoms of inflammation.

In addition to reducing pain, CBD and THC also decreased the instances of cramps and other colitis-related symptoms in rats(24). Results of the study conducted on rats may be useful in further studies to be conducted in humans.

The Pros and Cons of CBD Oil for Constipation

The Pros

  • Common symptoms of constipation, such as stomach pain, nausea, and bloating, may be alleviated by CBD oil, based on the studies presented.
  • CBD has a “good safety profile,” according to the World Health Organization(25). It means that the pharmacology and toxicology of the drug have little to no side effects.
  • There are various formulations of CBD products available. Hence, people with constipation can freely choose what products may work best for them.

The Cons

  • The US Food and Drug Administration (FDA) has not yet approved any CBD drug aside from Epidiolex, a CBD drug for severe forms of epilepsy(26)
  • One of the side effects of CBD is diarrhea(27), another digestive problem. 
  • Further clinical studies and trials are needed to support and validate the existing studies on constipation.

How CBD Oil Compares to Alternative Treatments for Constipation

Constipation can be managed with simple lifestyle changes. Some of the natural and alternative remedies for constipation are the following:

  • Traditional Chinese medicine practices, like acupuncture, acupressure, and moxibustion ( where mugwort is burned near the body’s acupuncture points)
  • Abdominal massage, which can help relax the abdominal muscles that control bowel movements
  • Homeopathy, which uses natural substances, such as plants and minerals, for treatment and healing
  • Biofeedback therapy, which focuses on controlling the body’s involuntary processes(28)
  • Dietary adjustments
    • Fiber-rich food, like whole grains, fruits, and vegetables
    • Probiotics, like drinks with beneficial bacteria called Lactobacillus casei Shirota(29)
  • Herbs and supplements
    • Psyllium, which is a soluble fiber supplement from the plant Plantago ovata and also known as a natural laxative
    • Flaxseed, which is a plant-based food that contains high fiber and fatty acids 

However, clinical trials are needed to measure the effectiveness of the treatments mentioned above(30).

Meanwhile, CBD is a natural compound that may potentially help with constipation problems. 

Hemp seeds from Cannabis sativa plants contain fiber and fatty acids. They may also contain trace amounts of THC(31).

A study conducted on rats displayed that hemp seed soft capsules (HSSC) made from hemp oil relieve constipation(32)

The HSSC increased the secretion of colon mucus essential in the formation of feces for a regular bowel movement. The result showed that the capsule might be a potential natural laxative for constipation patients.

How to Choose the Right CBD Oil for Constipation

There are three types of CBD to choose from that can address digestive problems, like constipation.

CBD isolate is the purest type of CBD, usually made with 99% concentration. The process of isolating other compounds from the product is called fractional distillation. The process uses heat to remove all other chemicals aside from CBD. 

This type of CBD is for those who want to try using CBD but do not want to get high.

The second type is the broad-spectrum CBD. This type of CBD contains all the beneficial compounds found in the cannabis plant without THC. It also has the benefits of the entourage effect or the unique benefits and effects of each compound combined sans THC.

The last type is the full-spectrum CBD. Based on its name, it has a complete set of active compounds, including THC. This type of CBD also has the full entourage effect with CBD.

Choosing the right CBD oil can be based on preference, lifestyle, and symptoms present. However, for maximum benefit, it is practical to use a full-spectrum CBD oil.

There are also factors to consider when choosing the best CBD oil:

  • Choose brands that use third-party laboratory tests for their products. A third-party lab certificate is a seal of approval, indicating that the product offerings are safe to use. 
  • Check the extraction method used in the product. Look for reputable manufacturers who are transparent about their production process. 
  • Take time to read product reviews, especially when buying from an online shop. When it comes to purchasing from a physician store, make sure that the store complies with the state laws about selling CBD products.
  • Look at the ingredient list to see if there are any synthetic ingredients included in the formulation. The Centers for Disease Control and Prevention issued a report about possible adverse effects of using synthetic cannabinoids(33)

CBD Dosage for Constipation

There is no regulated dosage of CBD by the FDA. Nevertheless, there are best practices that a person experiencing constipation can follow. 

For first-time users, a small amount and low dosage—around 1mg to 6mg—is a good starting point when taking CBD oil. After a week or if there are no significant improvements, the dosage may increase gradually until the desired result is reached. 

After taking the initial dosage, observe and take note of any significant changes or side effects. Record these results in a journal and show this to a doctor for advice.

The amount of CBD a person may take also depends on the body weight, condition, body chemistry, and concentration of the chosen CBD product. These factors should be considered first, so it is important to consult a physician who specializes in medical cannabis to know the possible effects and avoid any potential risks.

How to Take CBD Oil for Constipation

CBD products come in many different forms, shapes, and sizes. The most common one is the tincture. It is usually administered under the tongue (also called the sublingual method). This method absorbs the substance into the bloodstream through the mucous membranes found underneath the tongue. 

Another way of taking CBD is through vaping. This method enables CBD oil to enter the bloodstream through the lungs. This is the fastest method to obtain the therapeutic effects of CBD. However, the effects only last within a few minutes or hours.

Also available on the market are CBD edibles, such as gummies, brownies, pills, and capsules. These products take a long time to take effect but have a long-lasting impact on the body. 

CBD suppositories may also be effective for constipation relief. These products are rectal laxatives that are directly inserted in the rectum or anus for a direct stimulation on the bowel movement. 

There are also topical CBD products that are used for skin inflammations and infections. Products like lotions, balms, creams, and salves can be applied directly to the affected area. 

Aside from suppositories, mixing tinctures and oils with food or beverage is a recommended way of taking CBD for a more direct effect on the digestive system.

How Cannabinoids Work in the Digestive System

The ECS is linked with the GI in three ways, namely inflammation regulation, digestion, and brain communication. 

Inflammation Regulation

The cannabinoid receptors CB1 and CB2 both function as inflammatory mediators. When the GI is inflamed, the receptors regulate inflammation when activated by cannabinoids(34).

Digestive Process

One of the essential functions of ECS is regulating appetite. When phytocannabinoids stimulate CB1 receptors, a digestive action occurs. This action means nausea is controlled, stomach processes are slowed down, and acid reflux is relieved(35)

Brain and Gut Communication

A study suggested that ECS might be the bridge between the GI tract and the brain, allowing those two organs to interact(36). When the brain is filled with thoughts of stress or pain, the GI’s function is altered(37). This alteration between the two systems can cause conditions like IBS.

Similarities and Differences between IBS and IBD

IBS and IBD are both gastrointestinal conditions wherein constipation may occur. They share other similar symptoms, such as abdominal cramps and pain, diarrhea, and nausea. However, each condition has symptoms that differ from each other.

Irritable bowel syndrome is a disorder that targets the colon and disturbs the bowel function. It is characterized by changes in the bowel movement and urinary frequency.

There is no exact cause for IBS. However, studies have shown that it may be caused by the hypersensitivity of chemicals and nerves in the colon or abnormal bowel contractions caused by food or stress(38).

The type of IBS can be defined based on bowel movement. A person can either have diarrhea (IBS-D) or constipation (IBS-C) and IBS-M for mixed and IBS-U for unknown. Although IBS is not a severe condition and can be cured with dietary change and prescription medicines, it can bring discomfort and affect a person’s quality of life.

On the other hand, inflammatory bowel disease is a chronic condition caused by inflammation of the GI tract. Its symptoms include rectal bleeding, sudden weight loss, loss of appetite, fever, and anemia. 

Like IBS, IBD has no known cause. However, based on studies, it is caused by an immune system malfunction and other environmental factors(39)

Some environmental triggers that may cause IBD are frequent smoking, stress, and diet(40). Prescription medications for pain and inflammation, such as aspirin and NSAIDs, may also cause IBD.

There are two types of IBD, and these are Crohn’s disease and ulcerative colitis. 

Crohn’s disease usually starts with inflammation in the small intestine and colon. As the condition develops, the inflammation eventually spreads out to other parts of the GI tract. 

Ulcerative colitis is an inflammation of the colon and rectum’s lining, which develops sores or ulcers. These ulcers may bleed and produce pus that may infect the colon. 

People suffering from IBD are treated with medications. However, those with severe cases may need surgery. 

Surgery is necessary when symptoms get worse, medications can no longer control the symptoms, or serious complications start to happen.

The Legality of CBD

The use of CBD for medical purposes is allowed in 18 states in the United States(41). The majority of the states permit CBD use in severe neurological disorders, like epilepsy and seizures.

Out of the 18 states, two states highlighted CBD’s use for IBD, like Crohn’s disease and ulcerative colitis. These two states are Iowa and Georgia. 

Meanwhile, three states, namely Virginia, Wisconsin, and Kansas, legalized the use of CBD for any medically-diagnosed condition as long as a physician prescribes it.

Most of the states allow patients to use CBD if they are part of a state-funded clinical trial. The qualified patients are legally protected by the state laws to obtain CBD outside of the research environment. 

As a standard measurement for a patient’s possession, CBD products for medicinal purposes should contain at least 10% CBD and no more than 0.3% THC. Both percentages depend on product volume.

Similarities and Differences Between CBD and THC

There is confusion regarding the two commonly known cannabinoids found in cannabis, CBD and THC.

Both cannabinoids are found in two common species of cannabis, namely hemp and marijuana. The two plants differ in their CBD and THC content.

Hemp plants contain less than 0.3% THC, while marijuana contains a higher percentage of THC. THC is the compound that gives the high sensation. Although both plants contain THC, the high level of THC in marijuana makes it a psychoactive plant. 

Meanwhile, CBD has the opposite effect of THC. CBD is a non-psychoactive compound that does not elicit severe side effects(42)

Both compounds have the same chemical structure, meaning they have the same carbon, hydrogen, and oxygen atoms. 

However, they differ in how the atoms are arranged. The difference in the atomical arrangement also has varying effects on the human body. 

As the compounds react to the body’s ECS, they bind with the cannabinoid receptors that affect the standard bodily functions, such as sleep, appetite, and pain.

Conclusion

Constipation is a common digestive problem that affects around 2.5 million people around the world(43).

Although the symptoms are manageable, constipation may be a symptom of other underlying GI conditions, such as IBD and IBS. 

Guidance and supervision under a medical professional specializing in medical cannabis should be observed before engaging in any CBD treatment, especially if prior medications are taken.


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